1
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Zhang J, Lian R, Chen Y, Wan J. Serum antineutrophil cytoplasmic antibody positivity at the time of renal biopsy is associated with disease activity of lupus nephritis. Ren Fail 2024; 46:2357743. [PMID: 38847502 PMCID: PMC11163987 DOI: 10.1080/0886022x.2024.2357743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE To investigate the correlations between serum antineutrophil cytoplasmic antibody (ANCA) and clinicopathological features, induction treatment response, and prognosis of lupus nephritis (LN) patients. METHODS In this retrospective study, biopsy-proven LN patients from October 2010 to September 2020 were tested for serum ANCA by indirect immunofluorescence and ELISA and were divided into ANCA-positive group and ANCA-negative group. The clinicopathological data of the two groups were analyzed and compared. RESULTS Thirty-five of 115 patients (30.43%) were seropositive for ANCA. ANCA-positive patients had significantly higher systemic lupus erythematosus activity index and activity index scores, higher 24-h urinary protein, and lower complement three levels (p = 0.001, 0.028, 0.023, 0.009, respectively). The incidences of oral ulcers, thrombocytopenia, and leukocyturia, and the positive rates of anti-dsDNA antibody and anti-histone antibody were significantly higher in ANCA-positive group (p = 0.006, 0.019, 0.012, 0.001, 0.019, respectively). Class IV LN and fibrinoid necrosis/karyorrhexis were significantly more common in the ANCA-positive group (p = 0.027, 0.002). There was no significant difference in the total remission rate of ANCA-positive patients receiving cyclophosphamide and mycophenolate mofetil as induction therapies (83.33% vs. 66.67%, p > 0.05), while patients receiving cyclophosphamide as induction therapy had a higher total remission rate than those receiving other immunosuppressants (83.33% vs. 20%, p = 0.028). CONCLUSIONS LN patients with ANCA seropositivity at renal biopsy have a significantly higher disease activity, and their pathological manifestations are predominantly proliferative LN. These patients require a more active immunosuppressive therapy with cyclophosphamide or mycophenolate mofetil to improve their remission rate.
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Affiliation(s)
- Jing Zhang
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ruoshan Lian
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yi Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianxin Wan
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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2
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Nishisaka K, Ueda Y, Inoue M, Ishikawa M, Kageyama G, Saegusa J. Three cases of relapsed eosinophilic sinusitis without eosinophilia during mepolizumab maintenance therapy for eosinophilic granulomatosis with polyangiitis. Clin Rheumatol 2024:10.1007/s10067-024-07133-w. [PMID: 39249645 DOI: 10.1007/s10067-024-07133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/21/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024]
Abstract
We present three cases of eosinophilic granulomatosis with polyangiitis (EGPA) where patients experienced relapse of eosinophilic sinusitis without peripheral eosinophilia while on remission maintenance therapy with mepolizumab (MPZ), an anti-interleukin (IL)-5 monoclonal antibody. Despite the initial control of symptoms with high-dose prednisolone (PSL) and MPZ, patients experienced a relapse of nasal obstruction and eosinophilic infiltration in nasal mucosal biopsies. Notably, relapses occurred despite normal peripheral eosinophil counts, indicating the localized nature of eosinophilic inflammation. While IL-5 inhibitors effectively reduce peripheral blood eosinophils, eosinophilic sinusitis may persist due to local factors such as IL-4-mediated inflammation. IL-4 has been implicated in promoting eosinophil migration into nasal tissues, suggesting that IL-5 inhibitors alone may not sufficiently suppress eosinophilic infiltration in such cases. These findings highlight the importance of considering the possibility of eosinophilic sinusitis relapse in EGPA patients treated with IL-5 inhibitors and reduced glucocorticoid doses. Further research is warranted to elucidate the mechanisms underlying local eosinophilic inflammation and optimize treatment strategies for EGPA patients.
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Affiliation(s)
- Kazuma Nishisaka
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo Prefecture, 650-0017, Japan
- Department of Rheumatology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo Prefecture, 660-8550, Japan
| | - Yo Ueda
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo Prefecture, 650-0017, Japan
| | - Mie Inoue
- Department of Rheumatology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo Prefecture, 660-8550, Japan
| | - Masaaki Ishikawa
- Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo Prefecture, 660-8550, Japan
| | - Goichi Kageyama
- Department of Rheumatology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo Prefecture, 660-8550, Japan
| | - Jun Saegusa
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo Prefecture, 650-0017, Japan.
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3
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Banday AZ, Nisar R, Patra PK, Ahmad I, Gupta A. Basic Investigations in Pediatric Rheumatology. Indian J Pediatr 2024; 91:927-933. [PMID: 37676468 DOI: 10.1007/s12098-023-04821-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
The spectrum of pediatric rheumatological disorders is diverse and they are important differential diagnoses in a variety of clinical scenarios. Basic investigations not only provide supporting evidence for the diagnosis of a rheumatological illness but also help in exclusion of other diseases as well as for monitoring the activity of disease. Among these, complete blood count, biochemical assays including tests for inflammatory response, urine analysis, and various autoantibodies are often used. In addition, depending on the clinical features, imaging and tissue biopsies are used to confirm the diagnosis.
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Affiliation(s)
- Aaqib Zaffar Banday
- Department of Pediatrics, Government Medical College (GMC), Srinagar, Jammu and Kashmir, 190018, India.
| | - Rahila Nisar
- Department of Microbiology, Government Medical College (GMC), Baramulla, India
| | - Pratap Kumar Patra
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Imtiyaz Ahmad
- Department of Pediatrics, Government Medical College (GMC), Srinagar, Jammu and Kashmir, 190018, India
| | - Anju Gupta
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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4
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Luo J, Xie Z, Duan L. The Phenotypes and Functions of Neutrophils in Systemic Sclerosis. Biomolecules 2024; 14:1054. [PMID: 39334819 PMCID: PMC11429774 DOI: 10.3390/biom14091054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
Systemic sclerosis (SSc) is a chronic disease of the connective tissue characterized by its multifaceted impact on various bodily systems, yet its precise cause remains elusive. Central to its pathology are abnormal immune activation, vasculopathy, and consequent fibrosis affecting both the skin and internal organs. The intricate interplay between the innate and adaptive immune systems significantly influences the pathogenesis of SSc. Despite substantial research, the role of neutrophils, key players in innate immunity, in the context of SSc has remained enigmatic. Emerging evidence suggests that neutrophils not only contribute to the initiation and perpetuation of SSc but also inflict damage on organs and promote fibrosis-a hallmark of the disease in many patients. This review aims to investigate the nuanced involvement of neutrophils in the development of SSc. By shedding light on the intricate mechanisms through which neutrophils influence the pathogenesis of SSc, we can gain deeper insights into the disease process and potentially identify novel therapeutic targets. Understanding the precise role of neutrophils may pave the way for more targeted and effective interventions to alleviate the burden of SSc on affected individuals.
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Affiliation(s)
- Jiao Luo
- Jiangxi Province Key Laboratory of Immunity and Inflammation, Jiangxi Provincial People’s Hospital, Nanchang 330000, China; (J.L.); (Z.X.)
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People’s Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330000, China
| | - Zhongming Xie
- Jiangxi Province Key Laboratory of Immunity and Inflammation, Jiangxi Provincial People’s Hospital, Nanchang 330000, China; (J.L.); (Z.X.)
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People’s Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330000, China
| | - Lihua Duan
- Jiangxi Province Key Laboratory of Immunity and Inflammation, Jiangxi Provincial People’s Hospital, Nanchang 330000, China; (J.L.); (Z.X.)
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People’s Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330000, China
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5
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Stella M, Locatelli L, Sala FM, Reggiani F, Calatroni M, L'Imperio V, Pagni F, Maggiore U, Moroni G, Sinico RA. The value of the current histological scores and classifications of ANCA glomerulonephritis in predicting long-term outcome. Clin Kidney J 2024; 17:sfae125. [PMID: 38962252 PMCID: PMC11217817 DOI: 10.1093/ckj/sfae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 07/05/2024] Open
Abstract
Background Three different histological scores-histopathologic classification (Berden), Renal Risk Score (RRS) and the Mayo Clinic Chronicity Score (MCCS)-for anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) were compared to evaluate their association with patient and kidney prognosis of ANCA-GN. Methods Patients aged >18 years with at least 1 year of follow-up and biopsy-proven ANCA-GN entered this retrospective study. Renal biopsies were classified according to Berden's classification, RRS and MCCS. The first endpoint was end-stage kidney disease (ESKD), defined as chronic dialysis or estimated glomerular filtration rate <15 mL/min/1.73 m2. The second endpoint was ESKD or death. Results Of 152 patients 84 were males, with median age of 63.8 years and followed for 46.9 (interquartile range 12.8-119) months, 59 (38.8%) reached the first endpoint and 20 died. The Kaplan-Meier curves showed that Berden and RRS were associated with first (Berden: P = .004, RRS: P < .001) and second (Berden: P = .001, RRS: P < .001) endpoint, MCCS with the first endpoint only when minimal + mild vs moderate + severe groups were compared (P = .017), and with the second endpoint (P < .001). Among the clinical/histological presentation features, arterial hypertension [odds ratio (OR) = 2.75, confidence interval (95% CI) 1.50-5.06; P = .0011], serum creatinine (OR = 1.17, 95% CI 1.09-1.25; P < .0001), and the percentage of normal glomeruli (OR = 0.97, 95% CI 0.96-0.99; P = .009) were the independent predictors of ESKD at multivariate analysis. When the three scores were included in multivariate analysis, RRS (OR = 2.21, 95% CI 1.15-4.24; P = .017) and MCCS (OR = 2.03, 95% CI 1.04-3.95; P = .037) remained predictive of ESKD, but Berden (OR = 1.17, 95% CI 0.62-2.22; P = .691) did not. Conclusion RRS and MCCS scores were independent predictors of kidney survival together with high serum creatinine and arterial hypertension at diagnosis, while Berden classification was not.
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Affiliation(s)
- Matteo Stella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | | | - Filippo Maria Sala
- Nephrology Unit, ASST della Brianza, Vimercate Hospital, Vimercate, Italy
| | - Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Umberto Maggiore
- Department of Medicine and Surgery, Nephrology Unit, Azienda Ospedaliera-Universitaria Parma, University of Parma, Parma, Italy
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
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Walulik A, Łysak K, Błaszkiewicz M, Górecki I, Gomułka K. The Role of Neutrophils in ANCA-Associated Vasculitis: The Pathogenic Role and Diagnostic Utility of Autoantibodies. Int J Mol Sci 2023; 24:17217. [PMID: 38139045 PMCID: PMC10743134 DOI: 10.3390/ijms242417217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
Recent years have brought progress in understanding the role of the neutrophil, dispelling the dogma of homogeneous cells mainly involved in the prime defence against pathogens, shedding light on their pathogenic role in inflammatory diseases and on the importance of antineutrophil-cytoplasmic antibodies' pathogenic role in ANCA-associated vasculitides vasculitis (AAV). Myeloperoxidase (MPO) and proteinase 3 (PR3) expressed in neutrophil granulocytes are the most common targets for ANCAs and contribute to the formation of MPO-ANCAs and PR3-ANCAs which, released to the bloodstream, become an excellent diagnostic tool for AAV. In this study, we focus on increasing the clinical and experimental evidence that supports the pathogenic role of ANCAs in AAV. Additionally, we discuss the diagnostic utility of ANCAs for disease activity and prognosis in AAV. Understanding the central role of ANCAs in AAV is crucial for advancing our knowledge of these complex disorders and developing targeted therapeutic strategies in the era of personalized medicine.
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Affiliation(s)
- Agata Walulik
- Student Scientific Group of Adult Allergology and Internal Medicine, Wroclaw Medical University, 50-369 Wrocław, Poland; (A.W.); (I.G.)
| | - Kinga Łysak
- Faculty of Medicine, Medical University of Gdansk, 80-210 Gdańsk, Poland;
| | - Michał Błaszkiewicz
- Student Scientific Group of Adult Allergology and Internal Medicine, Wroclaw Medical University, 50-369 Wrocław, Poland; (A.W.); (I.G.)
| | - Ignacy Górecki
- Student Scientific Group of Adult Allergology and Internal Medicine, Wroclaw Medical University, 50-369 Wrocław, Poland; (A.W.); (I.G.)
| | - Krzysztof Gomułka
- Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wrocław, Poland
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7
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Abrantes AM, Montaño-Tapia L, Isenberg D. ANCA-MPO: is this a useful test? Rheumatology (Oxford) 2023; 62:e306-e308. [PMID: 37137279 PMCID: PMC10824551 DOI: 10.1093/rheumatology/kead173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/02/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Ana Mafalda Abrantes
- Division of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Instituto de Semiótica Clínica, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Lorena Montaño-Tapia
- Rheumatology Department, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - David Isenberg
- Department of Medicine, Centre for Rheumatology, University College London, London, UK
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8
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Zarur EB, Rodrigues SH, Ambrogini O, Ferraz MLG, Mastroianni-Kirsztajn G, Andrade LEC, Souza AWSD. Improvement of indirect immunofluorescence technique to detect antineutrophil cytoplasmic antibodies and its impact on test positivity rate. Braz J Med Biol Res 2023; 56:e12636. [PMID: 37493768 PMCID: PMC10361643 DOI: 10.1590/1414-431x2023e12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/10/2023] [Indexed: 07/27/2023] Open
Abstract
The indirect immunofluorescence (IIF) technique for antineutrophil cytoplasmic antibodies (ANCA) detection is subject to substantial differences across laboratories. This study aimed to assess the impact of improvements in the IIF-ANCA technique on the positivity rate of ANCA tests. A cross-sectional study was performed with serum samples from patients with ANCA-associated vasculitis (AAV), autoimmune hepatitis (AIH), and ulcerative colitis (UC). A paired analysis was performed for IIF-ANCA results using the traditional method and a modified protocol after a series of specific adjustments in the technique based on the protocol of IIF-ANCA test performed at a nation-wide private laboratory in Brazil. ANCA specificity was assessed by ELISA for anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) antibodies. Sixty-one patients were evaluated. The positivity rate of IIF-ANCA tests at disease presentation performed at the University reference laboratory was 32.3% in AAV, AIH, and UC patients, whereas the positivity rates of IIF-ANCA and ELISA tests in other laboratories were 75.0 and 72.7%, respectively. After modifications in the IIF-ANCA technique, there was a significant increase in the positivity rate (14.8 vs 34.3%; P=0.0002) and in median titers [1/40 (1/30-1/160) vs 1/80 (1/40-1/80); P=0.0003] in AAV, AIH, and UC patients. UC had the highest increment in positive results from 5.3 to 36.8%. There was poor agreement between MPO- or PR3-ANCA and both IIF-ANCA techniques. In conclusion, modifications in the IIF-ANCA protocol led to a significant improvement in its positivity rate and titers.
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Affiliation(s)
- E B Zarur
- Divisão de Reumatologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - S H Rodrigues
- Divisão de Reumatologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - O Ambrogini
- Divisão de Gastroenterologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - M L G Ferraz
- Divisão de Gastroenterologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - G Mastroianni-Kirsztajn
- Divisão de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - L E C Andrade
- Divisão de Reumatologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - A W S de Souza
- Divisão de Reumatologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Autoimmune complications of COVID-19 and potential consequences for long-lasting disease syndromes. Transfus Apher Sci 2023; 62:103625. [PMID: 36585276 PMCID: PMC9757887 DOI: 10.1016/j.transci.2022.103625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The latest WHO report determined the increasing diversity within the CoV-2 omicron and its descendent lineages. Some heavily mutated offshoots of BA.5 and BA.2, such as BA.4.6, BF.7, BQ.1.1, and BA.2.75, are responsible for about 20% of infections and are spreading rapidly in multiple countries. It is a sign that Omicron subvariants are now developing a capacity to be more immune escaping and may contribute to a new wave of COVID-19. Covid-19 infections often induce many alterations in human physiological defense and the natural control systems, with exacerbated activation of the inflammatory and homeostatic response, as for any infectious diseases. Severe activation of the early phase of hemostatic components, often occurs, leading to thrombotic complications and often contributing to a lethal outcome selectively in certain populations. Development of autoimmune complications increases the disease burden and lowers its prognosis. While the true mechanism still remains unclear, it is believed to mainly be related to the host autoimmune responses as demonstrated, only in some patients suffering from the presence of autoantibodies that worsens the disease evolution. In fact in some studies the development of autoantibodies to angiotensin converting enzyme 2 (ACE2) was identified, and in other studies autoantibodies, thought to be targeting interferon or binding to annexin A1, or autoantibodies to phospholipids were seen. Moreover, the occurrence of autoimmune heparin induced thrombocytopenia has also been described in infected patients treated with heparin for controlling thrombogenicity. This commentary focuses on the presence of various autoantibodies reported so far in Covid-19 diseases, exploring their association with the disease course and the durability of some related symptoms. Attempts are also made to further analyze the potential mechanism of actions and link the presence of antibodies with pathological complications.
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10
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Folci M, Ramponi G, Solitano V, Brunetta E. Serum ANCA as Disease Biomarkers: Clinical Implications Beyond Vasculitis. Clin Rev Allergy Immunol 2022; 63:107-123. [PMID: 34460071 DOI: 10.1007/s12016-021-08887-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 01/13/2023]
Abstract
Usually associated with autoimmune diseases, anti-neutrophil cytoplasmic antibodies are also detected in other conditions, such as infections, malignancies, and after intake of certain drugs. Even if the mechanisms of production and their pathogenic role have not been fully elucidated yet, ANCA are widely recognized as a clinically alarming finding due to their association with various disorders. While ANCA target several autoantigens, proteinase-3, and myeloperoxidase are the ones proved to be most frequently related to chronic inflammation and tissue damage in murine models. Albeit these autoantibodies could be present as an isolated observation without any implications, ANCA are frequently used in clinical practice to guide the diagnosis in a suspect of small vessel vasculitis. Conditions that should prompt the clinician to test ANCA status range from various forms of lung disease to renal or peripheral nervous system impairment. ANCA positivity in the presence of an autoimmune disease, especially rheumatoid arthritis, or connective tissue diseases, is frequently correlated with more clinical complications and treatment inefficacy, even in the absence of signs of vasculitis. For this reason, it has been postulated that ANCA could represent the final expression of an immune dysregulation rather than a pathogenic event responsible for organs damage. Recently, it has also been proposed that ANCA specificity (PR3 or MPO) could possibly define ANCA-associated vasculitides better than clinical phenotype. This review aims at summarizing the latest advancements in the field of ANCA study and clinical interpretation.
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Affiliation(s)
- Marco Folci
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Brunetta
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Graßhoff H, Fourlakis K, Comdühr S, Riemekasten G. Autoantibodies as Biomarker and Therapeutic Target in Systemic Sclerosis. Biomedicines 2022; 10:2150. [PMID: 36140251 PMCID: PMC9496142 DOI: 10.3390/biomedicines10092150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare connective tissue disorder characterized by immune dysregulation evoking the pathophysiological triad of inflammation, fibrosis and vasculopathy. In SSc, several alterations in the B-cell compartment have been described, leading to polyclonal B-cell hyperreactivity, hypergammaglobulinemia and autoantibody production. Autoreactive B cells and autoantibodies promote and maintain pathologic mechanisms. In addition, autoantibodies in SSc are important biomarkers for predicting clinical phenotype and disease progression. Autoreactive B cells and autoantibodies represent potentially promising targets for therapeutic approaches including B-cell-targeting therapies, as well as strategies for unselective and selective removal of autoantibodies. In this review, we present mechanisms of the innate immune system leading to the generation of autoantibodies, alterations of the B-cell compartment in SSc, autoantibodies as biomarkers and autoantibody-mediated pathologies in SSc as well as potential therapeutic approaches to target these.
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Affiliation(s)
- Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, 23538 Lübeck, Germany
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12
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Taeschler P, Cervia C, Zurbuchen Y, Hasler S, Pou C, Tan Z, Adamo S, Raeber ME, Bächli E, Rudiger A, Stüssi‐Helbling M, Huber LC, Brodin P, Nilsson J, Probst‐Müller E, Boyman O. Autoantibodies in COVID-19 correlate with antiviral humoral responses and distinct immune signatures. Allergy 2022; 77:2415-2430. [PMID: 35364615 PMCID: PMC9111424 DOI: 10.1111/all.15302] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several autoimmune features occur during coronavirus disease 2019 (COVID-19), with possible implications for disease course, immunity, and autoimmune pathology. In this study, we longitudinally screened for clinically relevant systemic autoantibodies to assess their prevalence, temporal trajectory, and association with immunity, comorbidities, and severity of COVID-19. METHODS We performed highly sensitive indirect immunofluorescence assays to detect antinuclear antibodies (ANA) and antineutrophil cytoplasmic antibodies (ANCA), along with serum proteomics and virome-wide serological profiling in a multicentric cohort of 175 COVID-19 patients followed up to 1 year after infection, eleven vaccinated individuals, and 41 unexposed controls. RESULTS Compared with healthy controls, similar prevalence and patterns of ANA were present in patients during acute COVID-19 and recovery. However, the paired analysis revealed a subgroup of patients with transient presence of certain ANA patterns during acute COVID-19. Furthermore, patients with severe COVID-19 exhibited a high prevalence of ANCA during acute disease. These autoantibodies were quantitatively associated with higher SARS-CoV-2-specific antibody titers in COVID-19 patients and in vaccinated individuals, thus linking autoantibody production to increased antigen-specific humoral responses. Notably, the qualitative breadth of antibodies cross-reactive with other coronaviruses was comparable in ANA-positive and ANA-negative individuals during acute COVID-19. In autoantibody-positive patients, multiparametric characterization demonstrated an inflammatory signature during acute COVID-19 and alterations of the B-cell compartment after recovery. CONCLUSION Highly sensitive indirect immunofluorescence assays revealed transient autoantibody production during acute SARS-CoV-2 infection, while the presence of autoantibodies in COVID-19 patients correlated with increased antiviral humoral immune responses and inflammatory immune signatures.
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Affiliation(s)
| | - Carlo Cervia
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
| | - Yves Zurbuchen
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
| | - Sara Hasler
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
| | - Christian Pou
- Science for Life LaboratoryDepartment of Women's and Children's HealthKarolinska InstitutetSolnaSweden
| | - Ziyang Tan
- Science for Life LaboratoryDepartment of Women's and Children's HealthKarolinska InstitutetSolnaSweden
| | - Sarah Adamo
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
| | - Miro E. Raeber
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
| | - Esther Bächli
- Clinic for Internal MedicineHirslanden Klinik St. AnnaLucerneSwitzerland
| | - Alain Rudiger
- Department of MedicineLimmattal HospitalSchlierenSwitzerland
| | | | - Lars C. Huber
- Clinic for Internal MedicineCity Hospital Triemli ZurichZurichSwitzerland
| | - Petter Brodin
- Science for Life LaboratoryDepartment of Women's and Children's HealthKarolinska InstitutetSolnaSweden
- Pediatric RheumatologyKarolinska University HospitalSolnaSweden
- Department of Immunology and InflammationImperial College LondonLondonUK
| | - Jakob Nilsson
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Onur Boyman
- Department of ImmunologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
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13
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Short-Term Effect of SARS-CoV-2 Spike Protein Receptor-Binding Domain-Specific Antibody Induction on Neutrophil-Mediated Immune Response in Mice. Int J Mol Sci 2022; 23:ijms23158234. [PMID: 35897803 PMCID: PMC9331224 DOI: 10.3390/ijms23158234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023] Open
Abstract
Vaccination protects against COVID-19 via the spike protein receptor-binding domain (RBD)-specific antibody formation, but it also affects the innate immunity. The effects of specific antibody induction on neutrophils that can cause severe respiratory inflammation are important, though not completely investigated. In the present study, using a mouse model mimicking SARS-CoV-2 virus particle inhalation, we investigated neutrophil phenotype and activity alterations in the presence of RBD-specific antibodies. Mice were immunized with RBD and a week after a strong antibody response establishment received 100 nm particles in the RBD solution. Control mice received injections of a phosphate buffer instead of RBD. We show that the application of 100 nm particles in the RBD solution elevates neutrophil recruitment to the blood and the airways of RBD-immunized mice rather than in control mice. Analysis of bone marrow cells of mice with induced RBD-specific antibodies revealed the increased population of CXCR2+CD101+ neutrophils. These neutrophils did not demonstrate an enhanced ability of neutrophil extracellular traps (NETs) formation compared to the neutrophils from control mice. Thus, the induction of RBD-specific antibodies stimulates the activation of mature neutrophils that react to RBD-coated particles without triggering excessive inflammation.
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14
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Biomarkers of Endothelial Damage in Distinct Phases of Multisystem Inflammatory Syndrome in Children. Metabolites 2022; 12:metabo12080680. [PMID: 35893247 PMCID: PMC9332590 DOI: 10.3390/metabo12080680] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Endothelial hyperinflammation and vasculitis are known hallmarks of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). They are due to the direct effect of the virus on endothelial cells enhanced by pro-inflammatory modulators and may cause venous/arterial thrombosis. Therefore, it is essential to identify patients with endothelial damage early in order to establish specific therapies. We studied the monocyte chemoattractant protein 1 (MCP-1), the perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), and the vascular endothelial growth factor A (VEGF-A) in serum from 45 MIS-C patients at hospital admission and 24 healthy controls (HC). For 13/45 MIS-C patients, we measured the three serum biomarkers also after one week from hospitalization. At admission, MIS-C patients had significantly higher levels of MCP-1 and VEGF-A than the HC, but no significant differences were observed for pANCA. While after one week, MCP-1 was significantly lower, pANCA was higher and VEGF-A levels were not significantly different from the admission values. These findings suggest an involvement of epithelium in MIS-C with an acute phase, showing high MCP-1 and VEGF-A, followed by an increase in pANCA that suggests a vasculitis development. The serum biomarker levels may help to drive personalized therapies in these phases with anticoagulant prophylaxis, immunomodulators, and/or anti-angiogenic drugs.
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15
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Thrombosis and Anticoagulation Therapy in Systemic Lupus Erythematosus. Autoimmune Dis 2022; 2022:3208037. [PMID: 35795725 PMCID: PMC9252713 DOI: 10.1155/2022/3208037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease in which pathogenic autoantibodies and immune complexes are formed and mediate multiple organ and tissue damage. Thrombosis is one of the most common causes of death in patients with SLE. Anticoagulant therapy blocks the vicious cycle between inflammation and thrombosis, which may greatly improve the long-term prognosis of patients with SLE. However, the etiology and pathogenesis of this disease are very complicated and have not yet been fully clarified. Therefore, in the present review, we will highlight the characteristics and mechanisms of thrombosis and focus on the anticoagulant drugs commonly used in clinical practice, thus, providing a theoretical basis for scientific and reasonable anticoagulant therapy in clinical practice.
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16
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Guthridge JM, Wagner CA, James JA. The promise of precision medicine in rheumatology. Nat Med 2022; 28:1363-1371. [PMID: 35788174 PMCID: PMC9513842 DOI: 10.1038/s41591-022-01880-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
Systemic autoimmune rheumatic diseases (SARDs) exhibit extensive heterogeneity in clinical presentation, disease course, and treatment response. Therefore, precision medicine - whereby treatment is tailored according to the underlying pathogenic mechanisms of an individual patient at a specific time - represents the 'holy grail' in SARD clinical care. Current strategies include treat-to-target therapies and autoantibody testing for patient stratification; however, these are far from optimal. Recent innovations in high-throughput 'omic' technologies are now enabling comprehensive profiling at multiple levels, helping to identify subgroups of patients who may taper off potentially toxic medications or better respond to current molecular targeted therapies. Such advances may help to optimize outcomes and identify new pathways for treatment, but there are many challenges along the path towards clinical translation. In this Review, we discuss recent efforts to dissect cellular and molecular heterogeneity across multiple SARDs and future directions for implementing stratification approaches for SARD treatment in the clinic.
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Affiliation(s)
- Joel M Guthridge
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Catriona A Wagner
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
- Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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17
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Liu S, Han L, Liu Y, Yang J, Zhang Y, Li M, Tian X, Zeng X, Wang L, Zhang F. Clinical Significance of MPO-ANCA in Eosinophilic Granulomatosis With Polyangiitis: Experience From a Longitudinal Chinese Cohort. Front Immunol 2022; 13:885198. [PMID: 35833130 PMCID: PMC9271578 DOI: 10.3389/fimmu.2022.885198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe aim of this study is to investigate the clinical significance of myeloperoxidase (MPO)–antineutrophil cytoplasmic antibody (ANCA) on eosinophilic granulomatosis with polyangiitis (EGPA) from a longitudinal Chinese cohort.MethodsA total of 120 patients with EGPA were consecutively enrolled and followed up. Two patients with PR3 ANCA was excluded and our analysis focused on the 118 patients with EGPA. On the basis of MPO-ANCA status, baseline clinical manifestations, treatment, and outcomes were analyzed. Logistic regression analysis was performed to analyze the independently associated factors for renal involvement.ResultsANCA positivity was observed in 24.2% of patients with EGPA. Patients with MPO-ANCA accounted for 20.8%. Patients with positive MPO-ANCA had higher levels of erythrocyte sedimentation rate (ESR), C-reactive protein, Birmingham Vasculitis Activity Score (BVAS), higher ratios of fever, myalgia, renal involvement, and biopsy-proven vasculitis. Heart manifestations and asthma were more common in patients with negative ANCA. Baseline MPO-ANCA titers positively correlated with ESR, eosinophil count, and BVAS and were higher in patients with methylprednisolone pulse. Among patients with renal involvement, patients with positive MPO-ANCA had higher proportions of female, fever, biopsy-proven vasculitis, and faster ESR; patients with negative ANCA developed more skin and cardiac involvement. MPO-ANCA positivity, male, and ear involvement were the independent factors associated with renal involvement. Intravenous cyclophosphamide and immunoglobulins were prescribed more frequently in patients with positive MPO-ANCA.ConclusionIn this cohort, patients with positive MPO-ANCA and negative ANCA displayed distinct clinical features, suggesting that MPO-ANCA might be a valuable biomarker for EGPA stratification. Baseline MPO-ANCA level correlated positively with disease activity of EGPA. MPO-ANCA was a significant independent factor associated with renal involvement.
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Affiliation(s)
- Suying Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Linna Han
- Department of Rheumatology and Clinical Immunology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanhui Liu
- Department of Rheumatology and Clinical Immunology, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Jun Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yu Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Li Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- *Correspondence: Li Wang, ; Fengchun Zhang,
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- *Correspondence: Li Wang, ; Fengchun Zhang,
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18
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Barreno-Rocha SG, Guzmán-Silahua S, Rodríguez-Dávila SDC, Gavilanez-Chávez GE, Cardona-Muñoz EG, Riebeling-Navarro C, Rubio-Jurado B, Nava-Zavala AH. Antiphospholipid Antibodies and Lipids in Hematological Malignancies. Int J Mol Sci 2022; 23:ijms23084151. [PMID: 35456969 PMCID: PMC9025841 DOI: 10.3390/ijms23084151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
One of the main groups of lipids is phospholipids, which are mainly involved in forming cell membranes. Neoplastic processes such as cell replication have increased lipid synthesis, making tumor cells dependent on this synthesis to maintain their requirements. Antiphospholipid antibodies attack phospholipids in the cell membranes. Three main types of antiphospholipid antibodies are recognized: anti-β2 glycoprotein I (anti-β2GP-I), anticardiolipin (aCL), and lupus anticoagulant (LA). These types of antibodies have been proven to be present in hematological neoplasms, particularly in LH and NHL. This review on antiphospholipid antibodies in hematological neoplasms describes their clinical relationship as future implications at the prognostic level for survival and even treatment.
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Affiliation(s)
- Sonia Guadalupe Barreno-Rocha
- Unidad de Investigación Epidemiológica y en Servicios de Salud, CMNO OOAD Jalisco Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (S.G.B.-R.); (S.G.-S.); (S.-d.-C.R.-D.); (G.E.G.-C.)
- Programa de Doctorado en Farmacología, Departamento de Fisiología, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Sandra Guzmán-Silahua
- Unidad de Investigación Epidemiológica y en Servicios de Salud, CMNO OOAD Jalisco Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (S.G.B.-R.); (S.G.-S.); (S.-d.-C.R.-D.); (G.E.G.-C.)
- Programa de Doctorado en Farmacología, Departamento de Fisiología, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Sinaí-del-Carmen Rodríguez-Dávila
- Unidad de Investigación Epidemiológica y en Servicios de Salud, CMNO OOAD Jalisco Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (S.G.B.-R.); (S.G.-S.); (S.-d.-C.R.-D.); (G.E.G.-C.)
| | - Guadalupe Estela Gavilanez-Chávez
- Unidad de Investigación Epidemiológica y en Servicios de Salud, CMNO OOAD Jalisco Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (S.G.B.-R.); (S.G.-S.); (S.-d.-C.R.-D.); (G.E.G.-C.)
- Programa de Doctorado en Farmacología, Departamento de Fisiología, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Ernesto Germán Cardona-Muñoz
- Programa de Doctorado en Farmacología, Departamento de Fisiología, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Carlos Riebeling-Navarro
- Unidad de Investigación en Epidemiologia Clínica, UMAE HP CMN-SXXI, Ciudad de México 06720, Mexico;
| | - Benjamín Rubio-Jurado
- Unidad de Investigación Epidemiológica y en Servicios de Salud, CMNO OOAD Jalisco Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (S.G.B.-R.); (S.G.-S.); (S.-d.-C.R.-D.); (G.E.G.-C.)
- Departamento Clínico de Hematología, División Onco-Hematologia, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
- Correspondence: (B.R.-J.); (A.H.N.-Z.)
| | - Arnulfo Hernán Nava-Zavala
- Unidad de Investigación Epidemiológica y en Servicios de Salud, CMNO OOAD Jalisco Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico; (S.G.B.-R.); (S.G.-S.); (S.-d.-C.R.-D.); (G.E.G.-C.)
- Programa Internacional de Medicina, Universidad Autónoma de Guadalajara, Guadalajara 44670, Mexico
- Departamento de Inmunología y Reumatología del Hospital General de Occidente, Secretaría de Salud Jalisco, Guadalajara 45070, Mexico
- Correspondence: (B.R.-J.); (A.H.N.-Z.)
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19
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Hakroush S, Kluge IA, Baier E, Korsten P, Tampe D, Ströbel P, Tampe B. pANCA autoantibody testing by indirect immunofluorescence indicates interstitial arteritis independent of MPO-ANCA immunoassays in ANCA-associated glomerulonephritis. J Nephrol 2022; 35:1251-1254. [PMID: 35381959 PMCID: PMC9107432 DOI: 10.1007/s40620-022-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Eva Baier
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Desiree Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany.
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20
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Silva DHM, Valente NYS, Oppenheimer AR, Oliveira AKGD. Granulomatous arteritis limited to the skin: case report and etiologic differential diagnosis. An Bras Dermatol 2022; 97:400-402. [PMID: 35331600 PMCID: PMC9133301 DOI: 10.1016/j.abd.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Agatha Ramos Oppenheimer
- Department of Dermatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
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21
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Sim NK, Liew SY, Warren DJ, Hassan A. Tolosa-Hunt syndrome presenting with features of a trigeminal autonomic cephalalgias and pituitary enlargement. BMJ Case Rep 2022; 15:e246519. [PMID: 35232735 PMCID: PMC8889159 DOI: 10.1136/bcr-2021-246519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
Tolosa-Hunt syndrome is understood as a steroid-responsive, relapsing-remitting, unilateral headache disorder associated with ipsilateral cranial neuropathies, of a probable granulomatous aetiology. The diagnosis is made clinically from the history and examination, supported by appropriate imaging. Here the authors report a case of Tolosa-Hunt syndrome with a headache phenotype mimicking a trigeminal autonomic cephalalgias (hemicrania continua), and serial MRI studies showing a stable enlarged pituitary. Due to her initial lack of clinical signs, she was diagnosed with chronic migraine, revised to hemicrania continua based on indomethacin response, then revised back to chronic migraine. Her final diagnosis was achieved after she developed a left cavernous sinus syndrome 4 years into her disease course. This case shows that Tolosa-Hunt syndrome may present with a non-side-locked headache and delayed development of clinical signs. Clinicians should also maintain a high degree of suspicion when faced with incidental MRI findings.
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Affiliation(s)
- Nicholas Keyi Sim
- Neurology, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - Sze Yii Liew
- School of Medicine, University of Leeds School of Medicine, Leeds, UK
| | - Daniel J Warren
- Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ahamad Hassan
- Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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22
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Brunetta E, Ramponi G, Folci M, De Santis M, Morenghi E, Vanni E, Bredi E, Furlan R, Angelini C, Selmi C. Serum ANCA and Overall Mortality: A 10-Year Retrospective Cohort Study on 1,024 Italian Subjects. Front Immunol 2021; 12:714174. [PMID: 34566970 PMCID: PMC8461098 DOI: 10.3389/fimmu.2021.714174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
Background Antineutrophil cytoplasmic antibodies (ANCA) are primarily involved in the pathogenesis of ANCA-associated vasculitides (AAV). However, ANCA may also be present in healthy subjects and in patients with autoimmune disorders different from AAV. We hypothesized that serum ANCA are associated with a worse prognosis in disorders other than AAV. Objective We investigated the association between the overall survival and the presence of serum ANCA in 1,024 Italian subjects with various testing indications in a 10-year interval. Methods In this retrospective cohort study, a population of 6,285 patients (many of whom were subsequently excluded due to our criteria) who tested for ANCA at a single center in 10 years was considered, and life status and comorbidities of subjects were collected. We compared the overall survival of ANCA-positive and ANCA-negative patients by means of Kaplan-Meier curves, while a multivariable adjusted Cox regression was used to evaluate the association between the ANCA status and the outcome (death) in terms of hazard ratios (HR) with 95% confidence intervals (CI). Results The positivity of perinuclear ANCA (pANCA) increased significantly mortality (HR, 1.60; 95% CI, 1.10–2.32), while cytoplasmic ANCA (cANCA) positivity failed to show a significant association (HR, 1.43; 95% CI, 0.77–2.68). The increased mortality rate was observed for both pANCA and cANCA in patients suffering from rheumatic disorders. No association was found between mortality and anti-MPO (HR, 0.63; 95% CI, 0.20–2.00) or anti-PR3 (HR, 0.98; 95% CI, 0.24–3.96) after adjusting for confounders. Conclusions Serum pANCA and cANCA are independent negative prognostic factors in patients with concurrent autoimmune diseases.
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Affiliation(s)
- Enrico Brunetta
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Marco Folci
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Elena Vanni
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Elena Bredi
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Raffaello Furlan
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Claudio Angelini
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
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23
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Lakhani DA, Balar AB, Adelanwa A, Gross A, Mohamed R, Smith KT, Kim C. Granulomatosis with polyangiitis: A case report and brief review of literature. Radiol Case Rep 2021; 16:3445-3450. [PMID: 34527120 PMCID: PMC8429614 DOI: 10.1016/j.radcr.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 02/08/2023] Open
Abstract
Granulomatosis with polyangiitis formerly known as Wegener's granulomatosis was first described by German pathologist Friedrich Wegener in 1936. It is a multi-system necrotizing noncaseating granulomatous vasculitis which affects small to medium-sized vessels. It can involve any organ system, most commonly the lungs and kidneys. American College of Rheumatology requires 2 of 4 criteria for diagnosis: Positive biopsy for granulomatous vasculitis, urinary sediment with red blood cells, abnormal chest radiograph and oral/nasal inflammation. Here we present a case of Granulomatosis with polyangiitis with brief review of literature.
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Affiliation(s)
- Dhairya A Lakhani
- Department of Radiology, Diagnostic Radiology Residency Program, Morgantown, WV 26506, USA,Corresponding author.
| | - Aneri B Balar
- Department of Radiology, Diagnostic Radiology Residency Program, Morgantown, WV 26506, USA
| | - Ayodele Adelanwa
- Department of Pathology, Anatomy and Laboratory Medicine; West Virginia University, Morgantown, WV 26506, USA
| | - Alexander Gross
- Department of Pathology, Anatomy and Laboratory Medicine; West Virginia University, Morgantown, WV 26506, USA
| | - Rehab Mohamed
- Department of Pathology, Anatomy and Laboratory Medicine; West Virginia University, Morgantown, WV 26506, USA
| | - Kelly T Smith
- Department of Radiology, Diagnostic Radiology Residency Program, Morgantown, WV 26506, USA
| | - Cathy Kim
- Department of Radiology, Diagnostic Radiology Residency Program, Morgantown, WV 26506, USA
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Sacchi MC, Tamiazzo S, Stobbione P, Agatea L, De Gaspari P, Stecca A, Lauritano EC, Roveta A, Tozzoli R, Guaschino R, Bonometti R. SARS-CoV-2 infection as a trigger of autoimmune response. Clin Transl Sci 2021; 14:898-907. [PMID: 33306235 PMCID: PMC8212749 DOI: 10.1111/cts.12953] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Currently, few evidences have shown the possible involvement of autoimmunity in patients affected by coronavirus disease 2019 (COVID-19). In this study, we elucidate whether severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) stimulates autoantibody production and contributes to autoimmunity activation. We enrolled 40 adult patients (66.8 years mean age) admitted to Alessandria Hospital between March and April 2020. All the patients had a confirmed COVID-19 diagnosis and no previously clinical record of autoimmune disease. Forty blood donors were analyzed for the same markers and considered as healthy controls. Our patients had high levels of common inflammatory markers, such as C reactive protein, lactate dehydrogenase, ferritin, and creatinine. Interleukin-6 concentrations were also increased, supporting the major role of this interleukin during COVID-19 infection. Lymphocyte numbers were generally lower compared with healthy individuals. All the patients were also screened for the most common autoantibodies. We found a significant prevalence of antinuclear antibodies, antineutrophil cytoplasmic antibodies, and ASCA immunoglobulin A antibodies. We observed that patients having a de novo autoimmune response had the worst acute viral disease prognosis and outcome. Our results sustain the hypothesis that COVID-19 infection correlates with the autoimmunity markers. Our study might help clinicians to: (a) better understand the heterogeneity of this pathology and (b) correctly evaluate COVID-19 clinical manifestations. Our data explained why drugs used to treat autoimmune diseases may also be useful for SARS-CoV-2 infection. In addition, we highly recommend checking patients with COVID-19 for autoimmunity markers, mainly when deciding on whether to treat them with plasma transfer therapy. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? ☑ Recent data sustain the idea that autoimmune phenomena exist in patients with coronavirus disease 2019 (COVID-19), but other investigations are necessary to define the possible link between severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection and autoimmune disease onset. WHAT QUESTION DID THIS STUDY ADDRESS? ☑ In this monocentric study, we demonstrated how SARS-CoV-2 infection could be associated with an autoimmune response and development of autoantibodies. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? ☑ Patients with COVID-19 having an increased level of inflammatory markers and strong autoantibodies positivity (i.e., antinuclear antibodies and antineutrophil cytoplasmic antibodies) presented the worst clinical outcome. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? ☑ These results suggest that the drugs normally used to treat autoimmune diseases should also be considered during SARS-CoV-2, improving public health. In addition, before starting a transfer plasma therapy, it is important to also evaluate the autoimmunity conditions of the patients with COVID-19. Transferring antibodies or trying to neutralize them should be done with precaution. It is possible that the risk of developing or increasing the autoimmune response may enhance.
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Affiliation(s)
- Maria C. Sacchi
- Autoimmunology and Analysis Laboratory Unit“SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
| | - Stefania Tamiazzo
- Autoimmunology and Analysis Laboratory Unit“SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
| | - Paolo Stobbione
- Rheumatology Unit“SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
| | - Lisa Agatea
- Laboratory DepartmentAffiliated to EuroimmunPadovaItaly
| | - Piera De Gaspari
- Neuroimmunology LaboratoryPediatric Research InstituteCittà della Speranza FoundationPadovaItaly
| | - Anna Stecca
- Laboratory DepartmentAffiliated to EuroimmunPadovaItaly
| | - Ernesto C. Lauritano
- Emergency Medicine Unit“SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
| | - Annalisa Roveta
- IRFI (Infrastruttura Ricerca Formazione Innovazione) “SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
| | | | - Roberto Guaschino
- Autoimmunology and Analysis Laboratory Unit“SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
| | - Ramona Bonometti
- Emergency Medicine Unit“SS Antonio e Biagio e Cesare Arrigo” HospitalAlessandriaItaly
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25
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Long Y, Feng J, Ma Y, Sun Y, Xu L, Song Y, Liu C. Altered follicular regulatory T (Tfr)- and helper T (Tfh)-cell subsets are associated with autoantibody levels in microscopic polyangiitis patients. Eur J Immunol 2021; 51:1809-1823. [PMID: 33764509 DOI: 10.1002/eji.202049093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/10/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022]
Abstract
Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is an autoimmune disease characterized by B cells-derived ANCAs, and ANCA was proved to be a key factor in its pathogenesis. Follicular regulatory T (Tfr) and follicular helper T (Tfh) cells were T-cell subsets that play important roles in B-cell maturation and antibody production. However, their significances in microscopic polyangiitis (MPA) patients, one type of AAV, has not been thoroughly studied. In this study, comprehensive pattern analyses of circulating Tfr and Tfh were performed in MPA patients and healthy controls (HCs), and we found Tfr levels and Tfr/Tfh ratios were significantly decreased in MPA patients. Compared with HCs, Helios+, CD45RA-FoxP3hi, and Ki-67+ Tfr were lower in MPA patients, while CD226+ Tfr cells were higher. These phenotypes suggest that function and proliferation ability of Tfr cells were relatively impaired. Tfh subsets, including ICOS+PD-1+ and Ki-67+ Tfh, were significantly increased, suggesting that the function of Tfh was enhanced in MPA although the total Tfh levels did not change significantly. Circulating memory B cells and plasmablasts were significantly elevated and negatively correlated with Tfr levels and Tfr/Tfh ratios in MPA patients. In addition, Tfr levels and Tfr/Tfh ratios were negatively while Tfh was positively correlated with serum myeloperoxidase (MPO)-ANCA levels. Furthermore, Tfr and Tfr/Tfh ratio were also reversely associated with SCr, BUN, IL-4, and IL-21 levels. Our results suggest that the imbalance of Tfr and Tfh functional subsets is related to increased level of autoantibodies in MPA patients, and we propose a new mechanism for the pathogenesis of MPA.
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Affiliation(s)
- Yan Long
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Jinghong Feng
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Yinting Ma
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Sun
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Lijuan Xu
- Department of Immunology, School of Basic Medical Sciences, Peking University Health Science Centre, Beijing, China
| | - Ying Song
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chen Liu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
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26
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Antineutrophil cytoplasmic antibodies (ANCA) - their role in pathogenesis, diagnosis, and treatment monitoring of ANCA-associated vasculitis. Cent Eur J Immunol 2021; 45:218-227. [PMID: 33456335 PMCID: PMC7792441 DOI: 10.5114/ceji.2019.92494] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a group of rare diseases characterized by necrotizing inflammation of small blood vessels and the presence of ANCA. Increasing clinical and experimental evidences support their pathogenic role in AAV, but the exact mechanism is not fully understood. Recently, the important role of neutrophil extracellular traps (NETs) in pathogenesis of AAV is underlined. There is an indication that NETs can be a source for the formation of ANCA. The most common ANCA target antigens are myeloperoxidase (MPO) and proteinase 3 (PR3). Though the mechanism of action of ANCA is still under exploration, ANCA serology is being increasingly used for classification of AAV and revealed as kenner in defining various disease subsets associated with different genetic background, clinical features, treatment response, and prognosis. Controversy exists regarding the utility of serial measurements of ANCA in patients with AAV to monitor treatment and predict disease relapse.
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Ramponi G, Folci M, De Santis M, Damoiseaux JGMC, Selmi C, Brunetta E. The biology, pathogenetic role, clinical implications, and open issues of serum anti-neutrophil cytoplasmic antibodies. Autoimmun Rev 2021; 20:102759. [PMID: 33476813 DOI: 10.1016/j.autrev.2021.102759] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/05/2020] [Indexed: 12/11/2022]
Abstract
Anti-neutrophil cytoplasmic antibodies (ANCA) are a group of autoantibodies, predominantly IgG, involved in the pathogenesis of several autoimmune disorders, detected either through indirect immunofluorescence or enzyme-linked immunosorbent assay. By means of indirect immunofluorescence, the main patterns are C-ANCA (cytoplasmic) and P-ANCA (perinuclear), while proteinase 3 (PR3) and myeloperoxidase (MPO) represent the main autoantigens in granulomatosis with polyangiitis and microscopic polyangiitis, both belonging to the family of ANCA-associated vasculitis (AAV). While several experiments established the pathogenicity of MPO-ANCA, evidence remains elusive for PR3-ANCA and an additional target antigen, i.e. LAMP2, has been postulated with specific clinical relevance. The presence of a subset of AAV without ANCA may be explained by the presence of further target antigens or the presence of molecules in blood which make ANCA undetectable. A rise in ANCA titers is not necessarily predictive of a flare of disease in AAV if not accompanied by clinical manifestations. ANCA may develop through variable mechanisms, such as autoantigen complementarity, apoptosis impairment, neutrophil extracellular traps dysfunction and molecular mimicry. We will provide herein a comprehensive review of the available evidence on the biological mechanisms, pathogenetic role, and clinical implications of ANCA testing and disease management. Further, we will address the remaining open challenges in the field, including the role of ANCA in inflammatory bowel disease and in cocaine-induced vasculitis.
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Affiliation(s)
- Giacomo Ramponi
- Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Milan, Italy
| | - Marco Folci
- Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Milan, Italy
| | - Maria De Santis
- Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Milan, Italy
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, Netherlands
| | - Carlo Selmi
- Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Enrico Brunetta
- Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Milan, Italy
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Pan Y, He L. Perinuclear anti-neutrophil cytoplasmic antibody in systemic lupus erythematosus indicates more severe condition. Clin Biochem 2020; 89:38-43. [PMID: 33307059 DOI: 10.1016/j.clinbiochem.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the clinical significance of perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) in patients with systemic lupus erythematosus (SLE). METHODS This retrospective study included 120 SLE patients. All patients were divided into group p-ANCA+ and group p-ANCA-. Demographic characteristics, clinical symptoms, autoantibodies, laboratory tests and renal pathology were compared between these two groups. RESULTS Among 120 patients, 45 (37.5%) patients were p-ANCA+ and 75 (62.5%) patients were p-ANCA-. The occurrence of lupus nephritis was significantly higher in group p-ANCA+ (P = 0.046). For autoantibodies, the occurrences of anti-dsDNA, anti-nucleosome and anti-histone were significantly higher in group p-ANCA+ (P < 0.001, P = 0.004 and P = 0.006, respectively). Titers of anti-dsDNA antibody, erythrocyte sedimentation rate (ESR), serum beta-2-microglobulin (β2-MG) and systemic lupus erythematosus disease activity index (SLEDAI) were higher in group p-ANCA+ (P < 0.001, P = 0.021, P < 0.001 and P = 0.005, respectively), while albumin was significantly lower than p-ANCA- group (P = 0.012). There were no differences in the classification of lupus nephritis, activity index and chronicity index. p-ANCA correlated with lupus nephritis, anti-dsDNA antibody, anti-nucleosome antibody and anti-histone antibody, and also disease activity markers, such as titers of anti-dsDNA antibody, ESR, albumin, serum β2-MG and SLEDAI. CONCLUSION The appearance of p-ANCA in SLE indicated high probability of lupus nephritis and more severe condition.
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Affiliation(s)
- Ying Pan
- Department of Rheumatology and Immunology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road No. 277, Xi'an, Shaanxi, China.
| | - Lan He
- Department of Rheumatology and Immunology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road No. 277, Xi'an, Shaanxi, China.
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29
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Chen XW, Chen DH, Wu SZ, Xie N, Liu WK, Lin YN, Zhang YW, Zeng QS. [Value of anti-neutrophil cytoplasmic antibody in assessing the severity of bronchiolitis obliterans in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:990-995. [PMID: 32933632 PMCID: PMC7499437 DOI: 10.7499/j.issn.1008-8830.2003326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the value of anti-neutrophil cytoplasmic antibody (ANCA) in assessing the severity of bronchiolitis obliterans (BO) in children. METHODS A prospective analysis was performed on 59 children who were diagnosed with BO from June 2009 to October 2014. ELISA was used to measure the concentrations of myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA in serum. According to the results of ELISA, the children were divided into three groups: double-negative ANCA (n=22), single-positive ANCA (n=17), and double-positive ANCA (n=20). The three groups were compared in terms of the scores of BO risk factors, clinical symptoms, chest high-resolution computed tomography (HRCT), and lung pathology on admission, as well as the changes in the expression level of ANCA and the scores of clinical symptoms and chest HRCT over time. RESULTS Compared with the double-negative ANCA group, the double-positive ANCA group had a significantly higher score of BO risk factors (P<0.05), and the single-positive ANCA group and the double-positive ANCA group had significantly higher scores of clinical symptoms, chest HRCT, and lung pathology (P<0.05). The children were followed up for 6 months after discharge, and there were significant reductions in MPO-ANCA and PR3-ANCA titers from admission and discharge to the end of follow-up (P<0.05), as well as a significant reduction in the score of clinical symptoms from admission to the end of follow-up (P<0.05), while there was no significant change in the score of chest HRCT from admission to the end of follow-up (P>0.05). The single-positive ANCA and double-positive ANCA groups still had a significantly higher score of clinical symptoms than the double-negative ANCA group (P<0.05). CONCLUSIONS The expression level of ANCA is correlated with the severity of BO in children and thus has certain clinical significance in disease evaluation.
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Affiliation(s)
- Xiao-Wen Chen
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
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30
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Lee MJ, Planck SR, Choi D, Harrington CA, Wilson DJ, Dailey RA, Ng JD, Steele EA, Hamilton BE, Khwarg SI, Rosenbaum JT. Non-specific orbital inflammation: Current understanding and unmet needs. Prog Retin Eye Res 2020; 81:100885. [PMID: 32717379 DOI: 10.1016/j.preteyeres.2020.100885] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
Non-specific orbital inflammation (NSOI) is a noninfectious inflammatory condition of the orbit. Although it is generally considered the most common diagnosis derived from an orbital biopsy, it is a diagnosis of exclusion, meaning that the diagnosis requires exclusion of a systemic process or another identifiable etiology of orbital inflammation. The clinical diagnosis of NSOI is ill-defined, but it is typically characterized by acute orbital signs and symptoms, including pain, proptosis, periorbital edema, chemosis, diplopia, and less commonly visual disturbance. NSOI poses a diagnostic and therapeutic challenge: The clinical presentations and histological findings are heterogeneous, and there are no specific diagnostic criteria or treatment guidelines. The etiology and pathogenesis of NSOI are poorly understood. Here we recapitulate our current clinical understanding of NSOI, with an emphasis on the most recent findings on clinical characteristics, imaging findings, and treatment outcomes. Furthermore, gene expression profiling of NSOI and its implications are presented and discussed.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Stephen R Planck
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Dongseok Choi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA; OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SWSam Jackson Park Road, Portland, OR, 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - David J Wilson
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Roger A Dailey
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - John D Ng
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Eric A Steele
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Bronwyn E Hamilton
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA; Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA; Devers Eye Institute, Legacy Health Systems, 1040 NW 22nd Avenue, Portland, OR, 97210, USA.
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Update on vasculitis: an overview and dermatological clues for clinical and histopathological diagnosis - part I. An Bras Dermatol 2020; 95:355-371. [PMID: 32307202 PMCID: PMC7253914 DOI: 10.1016/j.abd.2020.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 01/19/2020] [Indexed: 11/22/2022] Open
Abstract
The term vasculitis refers to the inflammation of vessel walls. It may range in severity from a self-limited disorder in one single organ to a life-threatening disease due to multiple organ failure. It has many causes, although they result in only a few histological patterns of vascular inflammation. Vessels of any type and in any organ can be affected, a fact that results in a broad variety of signs and symptoms. Different vasculitides with indistinguishable clinical presentations have quite different prognosis and treatments. This condition presents many challenges to physicians in terms of classification, diagnosis, appropriate laboratory workup, and treatment. Moreover, it compels a careful follow-up. This article reviews the Chapel-Hill 2012 classification, etiology, recent insights in pathophysiology, some important dermatological clues for the diagnosis and summarizes treatment of some of these complex vasculitis syndromes.
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Vojdani A, Vojdani E, Herbert M, Kharrazian D. Correlation between Antibodies to Bacterial Lipopolysaccharides and Barrier Proteins in Sera Positive for ASCA and ANCA. Int J Mol Sci 2020; 21:ijms21041381. [PMID: 32085663 PMCID: PMC7073094 DOI: 10.3390/ijms21041381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 12/17/2022] Open
Abstract
Individuals with intestinal barrier dysfunction are more prone to autoimmunity. Lipopolysaccharides (LPS) from gut bacteria have been shown to play a role in systemic inflammation, leading to the opening of the gut and blood-brain barrier (BBB). This study aims to measure antibodies against LPS and barrier proteins in samples positive for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) and compare them with these same antibodies in controls to determine whether a correlation between LPS and barrier proteins could be found. We obtained 94 ASCA- and 94 ANCA-positive blood samples, as well as 188 blood samples from healthy controls. Samples were assessed for antibodies to LPS, zonulin+occludin, S100B, and aquaporin-4 (AQP4). Results show significant elevation in antibodies in about 30% of ASCA- and ANCA-positive sera and demonstrate positive linear relationships between these antibodies. The findings suggest that individuals positive for ASCA and ANCA have increased odds of developing intestinal and BBB permeability compared to healthy subjects. The levels of LPS antibodies in both ASCA- and ANCA-positive and negative specimens showed from low and moderate to high correlation with antibodies to barrier proteins. This study shows that LPS, by damaging the gut and BBBs, contribute to the extra-intestinal manifestation of IBD. We conclude that IBD patients should be screened for LPS antibodies in an effort to detect or prevent possible barrier damage at the earliest stage possible to abrogate disease symptoms in IBS and associated disorders.
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Affiliation(s)
- Aristo Vojdani
- Immunosciences Lab, Inc. 822 S. Robertson Blvd, Ste 312, Los Angeles, CA 90035, USA
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
- Correspondence: ; Tel.: +1-310-657-1077
| | - Elroy Vojdani
- Regenera Medical, 11860 Wilshire Blvd., Ste. 301, Los Angeles, CA 90025, USA;
| | - Martha Herbert
- Martha Herbert, Pediatric Neurology, Massachusetts General Hospital, Rm CNY149-2nd Floor, Boston, MA 02114, USA;
| | - Datis Kharrazian
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
- Department of Neurology, Harvard Medical, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02129, USA
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Menezes JM, Rossener R, Silva APMAD, Rodrigues SS, Mangueira CLP. Comparison between enzyme-linked immunosorbent assay and indirect immunofluorescence for detection of antineutrophil cytoplasmic antibodies. EINSTEIN-SAO PAULO 2020; 18:eAO5132. [PMID: 31994608 PMCID: PMC6980292 DOI: 10.31744/einstein_journal/2020ao5132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the performance of enzyme-linked immunosorbent assay and indirect immunofluorescence methods for the detection of antineutrophil cytoplasmic antibodies in a routine clinical laboratory setting. Methods A total of 227 samples were tested by indirect immunofluorescence and enzyme-linked immunosorbent assay with antigen specificity for antiproteinase 3 and antimyeloperoxidase. The proportions of positive samples were compared by McNemar hypotheses and agreement was described by Cohen’s Kappa coefficient. Results The agreement of the tests was 96.5%, and the Kappa coefficient obtained was 0.70 (95%CI: 0.50-0.90; p<0.001). Considering indirect immunofluorescence as the gold standard, the sensitivity of the enzyme-linked immunosorbent assay was 0.62 and the specificity was 0.99, with diagnostic accuracy in 96% of cases. Some samples were negative in enzyme-linked immunosorbent assay and positive in indirect immunofluorescence. This situation occurred in all immunofluorescence patterns, but particularly in atypical patterns. Two samples with antiproteinase 3 positivity were considered negative in indirect immunofluorescence. Conclusion The enzyme-linked immunosorbent assay had high specificity but lower sensitivity. The performance of indirect immunofluorescence increases diagnostic sensitivity, while the search for antiproteinase 3 by enzyme-linked immunosorbent assay may also add diagnostic power.
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Affiliation(s)
- Julia Miranda Menezes
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Raissa Rossener
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Fijolek J, Wiatr E, Petroniec V, Augustynowicz-Kopec E, Bednarek M, Gawryluk D, Roszkowski-Sliz K. Antineutrophil cytoplasmic antibodies and their relationship with disease activity and presence of staphylococcal superantigens in nasal swabs in patients having granulomatosis with polyangiitis: results of a study involving 115 patients from a single center. Clin Rheumatol 2019; 38:3297-3305. [PMID: 31338700 DOI: 10.1007/s10067-019-04693-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/05/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Antineutrophil cytoplasmic antibodies (ANCAs) are considered a risk factor for granulomatosis with polyangiitis (GPA) exacerbation, especially when staphylococcal superantigens (SAgs) are present in nasal swabs. Their role in monitoring disease activity remains controversial. This study determined the relationship of ANCAs with disease activity and presence of SAgs in GPA patients. METHODS Among a total of 115 GPA patients hospitalized in the period 2009-2016, we investigated the presence of SAgs and ANCA concentration. Blood samples and nasal swabs were taken at each visit (referred further to as episodes). Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS). RESULTS We analyzed 362 episodes. ANCAs were detected in 215 (59.4%), while SAgs were detected in 126 (34.8%) episodes. We found a significant correlation between the presence of ANCAs and disease activity (p = 0.0032), as well as between their level and GPA severity (r = 0.25363, p = 0.000001). We also determined that an ANCA values ≥ 138 Ru/ml were an indicator of active disease with high specificity and low sensitivity (84.4% and 37.3%, respectively). The relationship between ANCA presence and the presence of SAgs was not confirmed; however, when SAgs were analyzed based on the different types, ANCA levels were found to be significantly higher in the group with SAg type B (p = 0.031). CONCLUSIONS There was no detectable evidence for the association between ANCA level and the presence of SAgs. Although monitoring ANCA levels as a marker of disease activity may be clinically relevant, GPA management cannot proceed on the basis of ANCA levels alone. Key Points • ANCA concentration usually correlates with GPA activity, although in half of patients, ANCAs persist despite effective treatment and clinical remission. • ANCA values of 138 Ru/ml seem to be an indicator of active disease with high specificity, but low sensitivity. • Although there is a relevance for ANCA monitoring as a marker of disease activity, GPA management cannot be based on ANCA levels alone. • The suspected clinical correlation between ANCA formation and SAg presence in nasal swabs is not obvious and requires further investigations.
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Affiliation(s)
- Justyna Fijolek
- The Third Department of Pneumonology, National Tuberculosis and Lung Diseases Research Institute, Plocka St 26, 01-138, Warsaw, Poland.
| | - E Wiatr
- The Third Department of Pneumonology, National Tuberculosis and Lung Diseases Research Institute, Plocka St 26, 01-138, Warsaw, Poland
| | - V Petroniec
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - E Augustynowicz-Kopec
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - M Bednarek
- The Second Department of Pneumonology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - D Gawryluk
- The Third Department of Pneumonology, National Tuberculosis and Lung Diseases Research Institute, Plocka St 26, 01-138, Warsaw, Poland
| | - K Roszkowski-Sliz
- The Third Department of Pneumonology, National Tuberculosis and Lung Diseases Research Institute, Plocka St 26, 01-138, Warsaw, Poland
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ANCA-Associated Vasculitides and Hematologic Malignancies: Lessons from the Past and Future Perspectives. J Immunol Res 2019; 2019:1732175. [PMID: 31198793 PMCID: PMC6526571 DOI: 10.1155/2019/1732175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/18/2019] [Indexed: 12/19/2022] Open
Abstract
The purpose of this paper is to collect and summarize all evidences relating to an association between ANCA-associated vasculitides (AAVs) and hematologic malignancies, in the form of either a paraneoplastic vasculitis or leukemias and lymphomas developing on a preexisting vasculitis. Additionally, the role of cyclophosphamide in vasculitis treatment has been assessed and compared to rituximab. Paraneoplastic AAV seems to be an uncommon presentation of hemopathies. Hematologic malignancy risk in AAV is more likely to be increased by cyclophosphamide, although not yet definitely proven. Furthermore, the pathogenesis of ANCA-associated vasculitis has been reviewed with particular emphasis on the role of proteinase 3 (PR3) in fuelling granulomatosis with polyangiitis (GPA) inflammation. PR3 is a bactericidal protein expressed by neutrophilic granules and on their plasma membrane. Derangements in its expression and function have been linked to leukemias and GPA alike. PR3-derived PR1 peptide is being studied as an immunotherapy target in leukemia and multiple myeloma. This study is aimed at bringing together various evidences from the field of immunological and hematological research, at exposing contradictions, and at revealing novel insights on the association between ANCA-associated vasculitis and hematologic malignancies.
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Damoiseaux J, Bossuyt X. Clinical relevance of ANCA in small-vessel vasculitis: positioning of antigen-specific immunoassays. Clin Rheumatol 2018; 37:2015-2016. [DOI: 10.1007/s10067-018-4154-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
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